MINDFULNESS TOO! BRINGING THE PRACTICE HOME

Presented by Dianne Lemieux, Ph.D.

& Elaine Rodgers, R.N.

Mindfulness Oriented PsychotherapyPractice Options

1) A therapist may develop a personal formal or informal practice of mindfulness meditation in order to develop a more mindful presence in psychotherapy.

2) A therapist may utilize a therapeutic frame which is informed by their own practice of mindfulness, research or literature regarding mindfulness or Buddhist psychology.

3) A therapist may teach patients how to practice mindfulness. Germer, C. (2005)

Personal Inquiry

1) Am I interested in pursuing mindfulness practice for my own personal and or professional growth?

2) Am I willing to commit to a daily practice of mindfulness?

3) How would I like to incorporate mindfulness in my clinical, teaching or consulting practice?

4) What further training do I need?

Forms of Meditation Practice

• Concentration Practices use one-pointed focus on a single object (breath, sound, mantra, word, image) to calm and stabilize the mind. “Aim and sustain.”

• Mindfulness or awareness practices cultivate an open awareness on what is happening as it is happening without judgment. Also sometimes referred to as insight meditation or Vipassana in the Theravada Buddhist tradition.

Concentration MeditationSamatha (laser light beam)

• Samatha (Pali) : tranquility and concentration• Any object of awareness may be used as an object of

concentration • Internal objects: words, images, a spot on the body, the breath• External objects: candle flame, mandala, image, a dot on the

wall.• Benefit: calm, stable mind detached from emotional and

interpersonal involvement• In concentration practice, the mind is gently returned to the

object of meditation when we notice it has wandered.• The “Relaxation Response” (Benson, 1975)

Germer, C. (2005)

Mindfulness MeditationVipassana, Insight (searchlight)

• Sati (Pali): awareness, attention, remembering• Expanded focus on a wider range of objects as

they arise in awareness one at a time.• Benefits: Greater awareness of the personal

conditioning of our minds and an understanding of the mind itself

• May include any sense (sight, sound, touch, smell, taste, hearing) as well as thoughts and emotions

Germer, C. (2005)

Mindfulness/ConcentrationMeditations

• Concentration and mindfulness practices actually complement each other

• Mindfulness begins with concentration meditation. Once a certain stability of the mind is reached, the practioner shifts to a mindfulness focus.

• Research suggests that the two forms of meditation are in fact neurologically different

Lazar, S. (2005)

Definitions of Mindfulness

“Mindfulness is paying attention on purpose non-judgmentally in the present moment.” Kabat-Zinn, J. (1994)

“Mindfulness meditation is a consciousness discipline revolving around a particular way of paying attention in one’s life. It can be most simply described as the intentional cultivation of nonjudgmental moment-to-moment awareness.” Kabat-Zinn, J. (1996)

Definitions of Mindfulness

• Mindfulness is “self-regulation of attention so that it is maintained on immediate experience thereby allowing for increased recognition of mental events in the present moment” and “adopting particular orientation toward one’s experience that is characterized by curiosity, openness, and acceptance”

Bishop et al. (2004)

Components of Mindfulness

• Intentionality• Present Centered Awareness• Acceptance/Non-Judgment

Mindfulness Practice is Not

• Trying to have a blank mind• Trying to achieve a special state of mind or trance state• Avoiding difficulties• Escaping physical pain• Pushing away thoughts or emotions• Bypassing our personality problems• Withdrawing from other people• A relaxation technique• A religion

Attitudinal Foundations of Mindfulness Practice

1. Non-Judging2. Patience3. Beginner’s Mind4. Trust5. Non-Striving6. Acceptance7. Letting Go

- Kabat-Zinn, J. (2005)

Modes of Practice

• Informal• Formal• Intensive Retreat

Guided Informal Practice/Discussion

Informal Practice ExamplesFor Daily Life

• Washing your hair• Brushing your teeth• Shaving• Taking a shower• Eating• Walking from your house to the car• Driving • Petting the dog • Washing the dishes (any chore)

Practice Opportunities For Mindfulness During The Day

• Waiting for 3 rings of the phone before answering

• Pausing before speaking• Notice getting up from your desk at work• Turning the computer on or off or switching

applications take a mindful pause• Notice the action of walking through doorways• Notice the action of picking something up• Pause after looking at the clock or your watch

Quick and Instant Practice(Helpful for Anxiety)

• Choose a reference point as a meditation bell• Stop and take three slow deep breaths• Bring the mind to the present moment on the in

breath• Scan the body and relax as much as you can any

tension held in the body on the out breath• Notice any thoughts/emotions• Proceed with what you had been doing

Quick and Instant Practice(with visualization)

• Choose a reference point as a meditation bell• Stop and take three slow deep breaths• With each exhalation repeat the phrase “I feel

calm, relaxed and at peace” or choose another phase that you resonate with. (Your visualization is a function of your intention for yourself.)

• Proceed with what you had been doing

MBCTThe 3-Minute Breathing Space Basic Instructions

1. AwarenessBring yourself into the present moment by deliberately adopting an erect and dignified posture. If possible, close your eyes. Then ask: “What is my experience right now…in thoughts…,in feelings…and in bodily sensations?”

2. GatheringThen, gently redirect full attention to breathing, to each in-breath and to each out-breath as they follow, one after the other.Your breath can function as an anchor to bring you into the present and help you tune into a state of awareness and stillness.

MBCTThe 3-Minute Breathing Space Basic Instructions Continued

3. ExpandingExpand the field of your awareness around your breathing, so that it includes a sense of the body as a whole, your posture, and facial expression.

The breathing space provides a way to step out of automatic pilot mode and reconnect with the present moment.The key skill in using Mindfulness-based Cognitive Therapy (MBCT) is to maintain awareness in the moment. Nothing else.

Segal, Z., Williams, J., Teasdale, J (2002)

On The Spot Informal Practices

1)Whenever you encounter distress this week, turn your attention toward it.2) If your reaction is overwhelming to a particular part of the practice, take a break and switch to lovingkindness or mindfulness practice3) Choose one day this week to do a kindness for someone and pay attention to all of the kindnesses that come your way on that day. 4) Practice inner smile on a daily basis. 5) Choose one day to do walking Metta meditation.

Guided Formal Practice/Discussion

Examples of Formal Practice

• Sitting meditation• Standing meditation• Body Scan• Walking Meditation• Loving-Kindness/Compassion Practices• Contemplative Prayer• Yoga• Taiji• Qigong

Mindfulness Myths

1) I don’t have the time!2) I’m too restless!3) I am afraid of my mind!4) I won’t get anything done!5) It will take time away from my kids! 6) I can’t meditate!7) I’m too tired!

The Five Hindrances to Meditation (From the Pali Cannon)

• Attachment• Aversion• Sloth/Torpor • Restlessness/Worry• Doubt

Working with Attachment“Wanting Mind”

Desire, lust, obsession with sensory objects or spiritual desires• Shift the attention of the mind from the object

itself to the experience of the wanting mind. Equanimity practice is useful to bring in.

Working with Aversion

Hatred, frustration, impatience, guilt, depression, pain, resistance • Avoid going into the practice with the attitude “If

I’m mindful, it will go away”• Don’t bore into the aversion or it will feel like a

pressure cooker. Open attention wide and alternate between the aversive experience and sound and back (Titrating the experience with the spaciousness of sound.)

• Notice the quality of mind whatever it is

Working With Sloth/Torpor

Sleepiness, boredom• Recognize what is happening• Refrain from acting it out• Realize it is impermanent• Get interested in the changing nature of it• You may need more sleep!• Keep your eyes open• Switch to standing or moving meditation

Working with Restlessness“Wandering Mind”

Restlessness, agitation, often suppression of another affect that wants to be known• “Putting the bull in a big pasture”• Opening the field of awareness to seeing (with

a soft gaze) or hearing without noting• Attempt to stay as still as possible “vow

sitting”

Working with Doubt

Delusion, indecision, confusion, over intellectualizing• Don’t go into the storyline and stay out of the

content of the doubt• See what else is there

Intensive Retreat Practice

Breath Awareness

Set Up Instructions for Breathing Meditation

1) Settle into a comfortable posture in which you are relaxed but alert.2)Take a few long slow breaths connecting with the body and releasing any obvious tension.3) Allow the breath to return to normal.5) Feel your body as a whole with wide attention.4) Continue to scan through the body releasing any obvious tension as best you can.

Breath Practice Instructions

1) Become aware that you are breathing.2) What are the sensations?3) Let your attention center on the part of the body where you experience the breath most vividly.4) Let your attention focus on those sensations as you experience breathing in and breathing out.5) Note where your mind goes when it wanders.6) How has thinking impacted your experience? Has any tension returned?7) Let the mind open again to the breath.

Breath Practice Advantages

• Breathing is a neutral object of attention for most people so less likely to trigger reactivity

• The experience of breathing is present moment (as are all body centered foci)

• Breathing changes which allows for easier tracking

• Breathing is rhythmic and cyclic appearing and disappearing

Working With The Body

Working With Pain Or Discomfort

1) Bring your attention to the sensations themselves. If the body is in an awkward position that is doing harm, move to a more comfortable position, mindfully noting your intention to move and paying attention to the movement itself.2) If the pain is tolerable bring your attention to the sensations themselves and note the sensations. Be aware of any feeling tone as you note. These tones may underlie emotions your are also experiencing Note any emotions i.e.. “anxiety, anxiety” or “anger, anger” and return to noting the body sensations. As much as possible try to stay out of the story about the pain. Focus on the present moment instead of projecting into the future or slipping back to the past.

Working With Pain Continued

3) If the pain sensations are overwhelming, you can shift focus to your breath, sound or focus on a different part of the body such as your hands or the bottoms of your feet.

Working With Difficult Emotions

Body Awareness

1) Take three deep breaths and focus your attention on your body and a sense of presence releasing any obvious tension as best you can.2) Allow your posture to move into sitting or standing “with dignity” relaxed, comfortable and alert.3) Allow a slight inner smile to come to your lips.4) Allow the chest to open by rolling the shoulders back and letting them fall away from the ears.5) Relax the jaw, the knees and the hands.

R.A.I.N. PracticeRecognize: Notice what you are experiencing. Stay with the experience rather than thoughts about the experience (the story line), simply note what you are experiencing.

Accept/Allow: Allow the experience (emotion, thought, body sensation) to be as it is in the moment without trying to change it. Look for the impulse to avoid or cling to the experience.

Investigate: Explore the experience with an attitude of openness, curiosity and self-compassion. Watch for the impulse to judge.

Non-identification: Continue to investigate and note the stream of sights, sounds, body sensations, thoughts, emotions and other contents of the mind that come and go. Notice the difference within between claiming the experience as I, me, of mine and just noting the stream or flow of experience. Michelle McDonald

Using The Breathing Space- Extended Instructions

When you are troubled in thoughts or feelings:1. AwarenessObserve- bring the focus of awareness to you inner experience and notice what is happening in your thoughts, feelings, and bodily sensations.Describe, Acknowledge, Identify- put experiences into words, for example, say in your mind, “A feeling of anger is arising” or “Self-critical thoughts are here.”

2. Redirecting AttentionGently Redirect your full attention to the breath. Follow the breath all the way in and all the way out. Try noting “at the back of your mind,” “Breathing in…breathing out” or counting, "inhaling , one…exhaling, two…etc..”

Using The Breathing Space- Extended Instructions Continued

3.Expanding Attention1. Allow your attention to expand to the whole body-especially to any

sense of discomfort, tension, or resistance. If these sensations are there, then take your awareness there by “breathing into them” on the in breath, then breathe out from those sensations, softening and opening with the out- breath. Say to yourself on the out-breath, “It’s OK. Whatever it is , it’s OK. Let me feel it.”

Become aware of and adjust your posture and facial expression.As best you can, bring this expanded awareness to the next moments of your day. Segal, Z., Williams, J. , Teasdale, J. (2002)

Working With Difficult Thoughts

Working with Thoughts

• The brain is an organ that naturally produces thoughts.

• In meditation, there isn’t a need to look for thoughts.

• Some thoughts are merely a drifting away from our focus. With these, we can note them and return to our intentional focus of awareness

Working with Thoughts Continued

• Some thoughts are compelling.• With these we can note them and see if there is an

emotional tone to the noting.• If so we can utilize the instructions for working with

difficult emotions or with the body.• It is not necessary to investigate the contents of the

thoughts.• Notice how thoughts appear, persist, change and

disappear.• How does observing thoughts change them?

Mindful Movement

Walking Meditation

Qi Gong and Taiji

Yoga

Bringing In The Good

Cultivating The Four Wholesome States Of Mind

• Lovingkindness (metta)• Compassion (karuna)• Sympathetic Joy (mudita)• Equanimity (upekkha)

Lovingkindness (Metta) Meditation

• Metta Defined: lovingkindness, unconditional friendliness, boundless friendliness of the open heart toward others

• Masked/Near Enemy: possessive love, sentimentality, attachment

• Direct/Far Enemy: hatred, fear, closing down of the mind, constriction of the body mind and heart

• Progression: oneself, benefactor, dear friend, neutral person, difficult person, all beings

The budstands for all things, even for those things that don’t flower,for everything flowers, from within, of self-blessing,though sometimes it is necessaryto reteach a thing its loveliness,to put a hand on the brow of the flower, and retell it in words and in touch, it is lovely until it flowers again from within, of self-blessing -Galway Kinnell

Lovingkindness Traditional Phrases

• May I be safe• May I be well• May I be happy• May I have ease of well-being

Lovingkindness Variations

• May I be protected in all ways.• May my heart be filled with loving kindness.• May my body be healthy and strong.• May I live with ease and harmony.

• May I be safe from internal and external harm.• May I be as healthy and strong as it is possible for me to be.• May I have the peace and understanding that come from true

wisdom.• May I live my life with ease. • May I love myself unconditionally

Compassion (Karuna)

• Karuna defined: compassion, a resonating concern, the quivering of the heart in response to suffering

• Masked/Near Enemy: pity, righteous anger, overwhelming grief, fear, aversion

• Direct/Far Enemy: cruelty, gossip• Progression: a person with great suffering, self,

benefactor, friend, neutral person, difficult person, all beings

“Every conflict begins with thoughts of fear, animosity and aggression, which pass through some people’s minds and spread like wildfire. The only antidote to these aberrations is to take on fully the suffering of others.” -Matthieu Ricard

Self-Compassion

“A moment of self-compassion can change your entire day. A string of such moments can change the course of your life.” Christopher Germer

Self-Compassion Phrases

• This is a moment of suffering • Suffering is a part of life• May I be kind to myself in this moment • May I give myself the compassion I need

Neff, K. & Germer,C. (2009)

Compassion Practice

• I see your suffering.• I care about your suffering.• May your suffering end.• May the causes of your suffering end.• May your suffering end or if it cannot end may

you meet the suffering with gentleness, tenderness, and care.

• May you be free of your pain and sorrow • May you find peace.

Sympathetic Joy (Mudita)

• Mudita defined: appreciative joy, sympathetic joy, joy for the joy of others.

• Masked/Near Enemy: exuberance, attachment to happiness

• Direct/Far Enemy: envy, jealousy• Progression: a person who is currently

experiencing great happiness, friend, benefactor, neutral person, difficult person, all beings

“With Mudita the odds of experiencing increased happiness go up 6 billion to one. Those are very good odds!” -Dalai Lama XIV

Sympathetic Joy Phrases

• May your happiness and joy continue to grow.• May your happiness and good fortune

continue.• May they increase and never wane.• May your happiness and joy never leave you.• I am happy that you are happy.

Sympathetic JoyObstacles to Joy/Tormenting States of Mind

• Judgment• Comparing Mind• Prejudice/Discrimination• Demeaning Mind• Envy/Jealousy• Avarice/Selfishness• Boredom

Allies to Joy• Gratitude “count your

blessings”• Lovingkindness• Compassion• Rapture-our capacity to

take active delight

Equanimity (Upekkha)

• Upekkha defined: equanimity, evenness of mind/heart toward all beings, resting the mind before falling into extremes, a heartfelt connection with spacious balance immeasurable impartiality

• Masked/Near Enemy: indifference, apathy, callousness, uncaring distance

• Direct/Far Enemy: reactivity, attachment, aversion• Progression: neutral person, dear friend, benefactor,

difficult person, self• The Eight Vicissitudes: praise & blame, gain & loss, fame &

disrepute, pleasure & pain

Equanimity Practice• May we all accept things as they are.• May we be undisturbed by the comings and goings of events.• I will care for you but cannot keep you from suffering. I wish you happiness

but cannot make your choices for you.• I offer you my good will no matter what.• May I be open, balanced and at peace. • May my heart open to your journey.• My my heart be at ease with the outer/inner changing conditions of life.• May my heart/mind open to this experience with balance and ease.• May I accept/open to how it is right now. • This is how it is right now.• Whether I understand it or not, things are unfolding according to a lawful

nature.

“With an eye made quiet by the power of harmony, and the deep power of joy, we see into the life of things.” -William Wordsworth

Gratitude

Your Top Ten List

1)2)3)4)5)6)7)8)9)10)

Yoga

“When you slip inside, something happens. Something deep inside is awakened. You discover you are more than you previously thought yourself to be. And the way you live your life begins to change. If you do not want this awakening go to the movies. If you want this awakening, practice yoga. You get to make that choice every day for the rest of your life.” -Swami Nirmalananda Saraswati

Mindful Yoga

Mindful yoga is another form of mindful movement or mindful meditation. Yoga means “to yoke” or “to unite”. Yoga offers the opportunity to notice how the body and mind relate to each other. Because the body is always in the present moment, uniting the mind with the body helps bring the mind into the present moment.

Yoga and Lovingkindness/Guided Practice and

Discussion

Mindfulness in the Consulting Room One Size Does Not Fit All

• Cultural/Religious Concerns• Ego Strength/Severity of Diagnosis• Contraindications• Bibliotherapy• Outside referral to a MBSR, MBCT, DBT group• Adapting the protocol to the client rather than

the client to the protocol• Your own level of training and practice

The Mindfully Oriented Therapist

Finding Your Comfort Level on the Continuum

Training

• MBSR• MBCT• DBT• ACT• Other Avenues

Training Resources

Ethical Issues

• Sensitivity to religious and cultural issues• Informed consent• Evidenced based• Appropriate training and consultation

Lovingkindness and theDedication of Merit

May you be safeMay you be well

May you be happyMay you be free from suffering